Health care costs have resumed their rise at double-digit rates—after moderating in the early 1990's as managed care became widespread. The 2006 Towers Perrin Health Care Cost Survey reports that gross health care expenditures in the U.S. have increased by 140% over the past 10 years. This report can be found on-line at URL: http://www.towersperrin.com/tp/getwebcachedoc?webc=HRS/USA/2006/200605/li-nk.pdf.
Administrative costs represent a significant share of the $1.7 trillion that the U.S. currently is spending per year on health care. In a speech in March, 2006, Uwe Reinhardt, James Madison Professor of Political Economy at Princeton University, told a capacity crowd that the U.S. is spending $300 billion per year on health care administrative costs; an amount he believes could be sliced in half without affecting health outcomes [http://www.dukenews.duke.edu/2006/03/healthcosts.html].
Although many of the nation's providers have converted from paper to electronic records, much ground remains to be covered. Unfortunately, the rate at which systems are currently being converted is insufficient to materially offset the double-digit annual rate increases in health care costs. The present invention not only promotes the use of electronic records, but it also provides a method whereby, for the first time, a health care plan administrator can operate a health care plan in a fully automated mode, requiring neither the manual input of data or information, nor the manual review of claims. The present invention accepts on-line inputs from patients, physicians, other providers, an insurer and outside vendors, then processes the information and makes it available to those authorized to access it via an integrated and automated administrator.
In addition to controlling escalating health care costs, the ability to measure accurately health care quality—especially patient outcomes—has also been elusive. While the health care quality of entire facilities (e.g., hospitals, health plans) has been compared, little progress has been made with respect to comparing the performance of individual providers.
While some quality measurement systems, such as HEDIS [www.ncqa.org/programs/hedis/], compare compliance (e.g., the percentage of a providers' patients receiving vaccinations), none has been successful in providing a method for comparing the outcomes of individual providers. A persistent problem has been the difficulty in making comparisons of provider outcomes when patients initially face dissimilar recovery risks, due to illness severity, co-morbidities and other risk factors.
Accordingly methods and systems for fully automated health plan administration, including methods for making valid comparisons of provider outcomes, are needed.